DESCRIPTION (APPLICATION ABSTRACT): The long-term objective of the MEMO Study (Minimizing Error, Maximizing Outcome) is to determine the effect of the healthcare work environment on the quality of care and the role of physicians as mediators of this effect. Specific aims include: 1) to determine the effect of workplace characteristics on patient outcomes such as satisfaction, disease control and medical errors; 2) to determine if the lowest error rates and best outcomes occur in an environment with low physician stress and burnout, and to identify the elements of such an environment; and 3) to define how predictors of quality and errors differ between women and men physicians, minority and non-minority physicians, and urban and rural physicians. The MEMO Study is a longitudinal, observational study of 500 physicians and 3,000 of their patients in 5 clinical sites: New York, Chicago, Milwaukee, Madison and rural Wisconsin. Patients will have one or more of three conditions: hypertension, diabetes and chronic lung disease. The initial 6 month phase will include focus groups with physicians, other healthcare personnel, and patients where individuals can "tell their stories" about the successes and challenges of their day-to-day healthcare experiences. This information will be utilized to develop surveys for the second phase, a two year prospective evaluation of physicians, patients and their outcomes. Medical errors in treatment and diagnosis will be assessed via chart review at the conclusion of phase two. Phase three will consist of data analysis and dissemination activities, including preparation of non-technical monographs, and use of the "Knowledge Caf[unreadable] method at regional and national primary care meetings. One study outcome will be a "best practice index" listing workplace characteristics that result in low error rates and high quality care. This index will provide a menu for practice managers and healthcare organizations to use in determining how to best modify their practices to improve quality. Due to our diverse clinical sites, we anticipate being able to answer questions concerning physicians and patients in rural and inner-city settings. We also anticipate being able to answer questions about women and minority physicians, groups that are typically underrepresented in physician-centered research.